1. Field of the Invention
This invention describes a versatile trauma tourniquet with features permitting ease of application in the field, by incorporation into critical locations on a battle dress uniform or other clothing.
2. Description of Related Art
Wartime trauma from exploding devices and gunshot wounds results in a high incidence of life and limb-threatening injuries. Exsanguination from peripheral vascular injury is the primary preventable cause of death in field trauma, and has been well documented in literature regarding current war trauma.
Blood loss from non-fatal injuries to arms and legs also can contribute to morbidity to kidneys, liver and other vital organs due to hypotension. The loss of significant amounts of blood also increases the rate of consumption of blood products from the blood bank. Multiple extremity wounds can also complicate triage.
It is axiomatic that in combat, there is a “platinum 5 minutes” for major vascular injury. Even with quick triage, it often takes hours to transport casualties off the battlefield, and even if the distance is small, the hazardous nature of the forward combat areas frequently prevents medical personnel from quickly reaching the wounded. Hence the need for individual soldiers to have a readily available tourniquet that is safe and effective.
Thus, despite the advances in modern medical care for the battlefield, control of blood loss is the one immediate treatment that can be applied to or by an injured soldier to decrease the chance of organ injury, limb loss and death due to hemorrhage. A critical immediate danger is always focal vascular injury and uncontrolled hemorrhage.
Despite long-established use in the medical field, the need for new tourniquet technology is readily acknowledged. Hemorrhage from extremity wounds is the leading cause of preventable death on the battlefield, and tourniquets are the most viable option for controlling life-threatening extremity hemorrhage in the tactical phase of an operation. The evolution of tourniquet technology has been a marked response to the realities of fighting in Iraq and Afghanistan.
Tourniquet designs are varied. One recent patent, U.S. Pat. No. 6,189,538, describes a non-pneumatic tourniquet for use in treating deep vein thrombosis that includes a band having a first end and a second end, wherein the first end and second end have a structure for adjustably connecting to one another, shown as hook and loop-type fasteners, and an adjustable disc made of a substantially hard, non-compressible material connected to the band. Provided is a method of treating deep vein thrombosis in which the thrombus cannot be easily treated using a catheter.
U.S. patent application No. 2007/0005107 is directed to a military emergency tourniquet, described as a tourniquet for rapidly and easily reducing or stopping blood flow to a limb. The tourniquet utilizes a hook and loop system and includes a twistable strap, a base including two opposing entry apertures and an exit aperture, a windlass and at least one receiving loop.
U.S. Pat. No. 4,182,338, provides a pressure applying device which prevents bleeding through needle puncture wounds by applying pressure to the wound through an elastomeric appliance having a blunt skin abutting surface held in place over the wound by securing straps. The pressure applied by the device is sufficient only to prevent bleeding through the wound and does not impede the subsurface flow of blood.
The most commonly used tourniquet, however, is still a length of surgical tubing or penrose drain, the tourniquet used in phlebotomy. However, such tubing does not function well for greater than 1-2 minutes because of the pain.
A continuing problem in the field, then, is the need for rapid and safe protection for the soldier for injuries to the extremities. Vascular injury alone can result in amputations from blood loss and resulting ischemic muscle. The existing tourniquets available to the combat infantryman, as well as medical personnel, vary in degree of mechanical/clinical failure, often due to complicated and time consuming application. In addition, certain designs are painful, either inadequately or too adequately diminish blood-flow, or are too bulky for routine field use.
Ease of use and effectiveness of the application are critical to saving lives and limbs during those platinum 5 minutes, yet according to the U.S. Army Institute of Surgical Research, current technology has reportedly fostered misapplications, intolerable pinching and skin/tissue damage, and has yet to take effective control of leg injuries. Studies have shown that tourniquet failure has revolved around several issues: 1) inadequate mechanical advantage for tightening, 2) device failure (i.e., breakage), and 3) intolerable pinching or circumferential pain prior to pulse elimination. While one-handed tourniquet technologies have even been able to minimize blood flow in the arm to some extent, no one-handed technology has been found to be successful in easily and reliably decreasing blood flow to the lower extremity.
In April 2007, a comparative report from The Naval Sea Systems Command was released to the public. This comprehensive review of available field tourniquets compares 13 designs from 12 manufacturers. The comparison was conducted under rigorous clinical standards, and the comments from failed applications provide great insight into the application realities of tourniquet designs. They also demonstrated the need for versatility and immediate availability of a simple, strong and effective tourniquet in the field.
There remains, then, a need for a life and limb saving tourniquet, for military use and other use that can overcome the obstacles of current technology.